Doctor Name: | DR. RENE EARLE GRACE |
NPI Number: | 1578686291 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | D002259 |
Business Practice Address: | 7503 Surratts Road Clinton, MD - 20675 |
Business Phone Number: | 3019943366 |
Business Fax Number: | |
Mailing Address: | P.o. Box 250, PINEY POINT |
State: | MD |
Postal Code: | 20674 |
Phone Number: | 3019943366 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | D002259 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |